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Medical advancements have significantly increased life expectancy, and people over the age of 65 (older adults) are the fastest-growing population in the world (World Health Organization 2015). Population aging has brought to the fore prevailing under-discussed public health issues such as self-neglect. The National Centre on Elder Abuse (NCEA) posits that Self-Neglect (SN) is ‘the behaviour of an elderly person that threatens his/her own health and safety’ (Adminstration on Aging 2016). Self-neglect can vary in presentation and severity and was first identified in the 1950s. A variety of terms such as Diogenes syndrome (Reyes-Ortiz et al. 2014), and domestic squalor (Snowdon et al. 2012) have been used to describe and define self-neglect (Gibbons et al. 2006; Lauder et al. 2009). A concept anlysis by Day (2016) concluded that self-neglect can manifest both externally and internally and defining attributes were environmental neglect and cumulative behaviors (service refusal, isolation, poor social networks, reduced engagement, poor self-care, neglect of health, hygiene, nutrition, and finances) that could be intentional or non-intentional.

Background The Public Health Intervention Wheel (PHIW) is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. Public health nurses (PHNs) provide care at the three levels of practice. Prevention of falls is a public health issue and the majority of falls happen at home. Therefore, prevention and management of falls in the community could benefit from a public health systems approach by PHNs underpinned by the PHIW. Case presentation A hypothetical case is presented of a 78-year-old gentleman who had a fall which resulted in a fractured right acetabulum and surgery before being discharged home. Methods The aim of this paper was to use a case summary to illustrate PHN practice in the context of the PHIW as applied to falls management and prevention. This paper focuses on fall incidence and PHN response in Ireland and Norway. The PHIW is described and relevant interventions from the PHIW are applied to PHN practice in managing the case. Conclusions The PHIW model provides insight into the potential scope of public health nursing in falls, articulating PHN practice in the community.

Aim To examine the perceptions of nurse managers, registered nurses and healthcare assistants of physical restraint use on older people in a long-term care setting in the Republic of Ireland. Background The use of physical restraint, although controversial, persists in long-term care settings, despite recommendations for restraint-free environments. Perception and attitude of staff can influence use of physical restraint. Methods A descriptive cross-sectional design was used. A total of 250 nursing and healthcare assistant staff were recruited. A questionnaire incorporating demographics and the Perceptions of Restraint Use Questionnaire was used. Descriptive and inferential statistical analyses were conducted. Results Mean age of respondents (n = 156) was 41 years, and the majority were female. Overall, a low level of importance was attached to the use of restraint. Nurse managers and registered nurses compared favourably with healthcare assistants who attached a higher importance to use of restraint. Across all three staff groups, greatest importance was attached to the use of physical restraint for reducing falls, followed by prevention of treatment interference. Restraint was least favoured as a means of impairment management. Education was not an explanatory factor in perceived importance of physical restraint use. Conclusion Nurse managers and registered nurses are unlikely to use physical restraint. However, there is concern regarding perception of healthcare assistants on use of restraint. Implications for nursing and health policy Results from this study compare favourably with those in countries that have no policy on physical restraint use. Educational programmes alone are insufficient to address use of physical restraint. Attention to skill mix with adequate support for healthcare assistants in long-term care settings is recommended.

Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.

Background: The extent of self-neglect on public health nurses' (PHNs) caseloads in Ireland is unknown. People who self-neglect may be vulnerable or hidden and, as a consequence, difficult to profile. PHNs in Ireland profile their areas to identify the nursing needs of their population. Aim: This paper aims to: collate caseloads on self-neglect on the basis of a review of community profile and health need assessments (CPHNA) and identify the geographical and demographic factors within which self-neglect cases were found. Method: A retrospective review of the CPHNA of student PHNs (n=88) was undertaken from 2010 to 2014 in a university in Ireland. In all, 88 community profiles were manually reviewed. Results: A total of 374 self-neglect cases were identified—79 cases were aged between 18–64 years and 295 were over 65 years. The range of self-neglect cases per profiled area was between 0 to 25. The geographic and demographic factors linked to self-neglect across profiles were higher rates of older people, deprivation, disadvantage, and cultural factors. Conclusion: This retrospective review illustrates that self-neglect is a prominent feature in PHN caseloads, which has not been identified previously. Early identification is important to promote the mental health and wellbeing of self-neglecting clients.

Background self-neglect (SN) is a global health and social problem affecting societies, which is largely hidden, under-reported and underresearched. Community nurses (CNs) and social workers (SWs) need to be knowledgeable about SN. Objective to determine CNs and SWs sources and level of SN knowledge. Methods quantitative, descriptive and cross-sectional. Subjects CNs and SWs working in the community with older people at risk of SN. Settings participants were recruited from four Health Service Executive (HSE) areas in Ireland. Instrument a questionnaire was developed to elicit levels and sources of SN knowledge. A postal survey was used. Results of the 566 questionnaires posted, 339 responded (Nurses (N) N = 305; SWs N = 34), a 60% response. SWs had statistically higher knowledge scores (P = 0.002), and difference in average scores between CNs and SWs was statistically significant (P = 0.037). There was a statistically significant difference between practice and personal experience (P = 0.44), and use of literature/books (P = 0.037) between CNs and SWs, with SWs using both sources more. Higher knowledge scores were significantly associated with number of SN cases, higher education and gender. Conclusion there is a need for interdisciplinary training on SN.

Older people are at an increased risk of developing multiple co-morbidities causing subsequent cognitive, functional decline and frailty and increasing the risk of adverse healthcare outcomes. Public Health Nurses (PHNs), geriatricians and researchers developed the Risk Instrument for Screening in the Community (RISC) to record the presence of problems, severity (mild, moderate, severe) of concerns and caregiver networks’ ability to manage the patient across three domains: mental state, activities of daily living and medical state. The aim of this study was to explore the experiences of healthcare professionals who had used the RISC with community-dwelling older adults, between countries. Five focus groups (n = 28) were conducted in five countries (Australia, Northern Ireland, Portugal, Republic of Ireland and Spain). Four main themes were identified from participants’ experiences using the RISC: ‘Tool Usability’; ‘Benefits for Patients and Carers’; ‘Operational Challenges’; and ‘Recommendations for Improvement’. Some cultural differences were found between participants with regards to terminologies such as ‘caregiver network’ and ‘insight’ and expectation in relation to caring. Disciplinary differences were identified related to different conceptualisations of health. The RISC offers an innovative approach to identify and score risk in community dwelling older adults. However, further research is necessary to reflect cultural and disciplinary norms.

Introduction: The home of an older person can impact on their physical and mental health. Social housing (rental housing provided on a subsidised basis to people who cannot afford housing from their own resources) for older people in Ireland includes standard design dwellings, and purpose-built “sheltered housing” where residents have access to additional supports on site. It was important that older people’s views on the relative merits of both models of social housing were ascertained, to aid future housing and social care planning in Ireland. Theory/Methods: A mixed-methods research design, using quantitative and qualitative methodologies, was employed. A survey was performed of tenants (aged ≥60) of a large, not-for-profit, Irish housing association, living in standard (representative sample; n=413) or sheltered social housing (census survey; n=415). Assistance was provided to complete surveys by telephone if required. Six focus-groups were conducted, three each with standard and sheltered scheme tenants, in Cork, Dublin, and Longford, to explore themes further. Results: Overall, 380 surveys were returned (46.0% response rate, standard housing; 48.4%, sheltered). Thirty-one people, aged 60-96, participated in focus groups. Tenants in standard houses reported more disability/illnesses, worried more about the future (especially the risk of falls), felt less safe at home, and were more lonely. However, few wanted to move. Residential care was negatively viewed and most were unaware of sheltered housing schemes. Conversely, older people in sheltered housing were more satisfied with the physical design of their home and reported more positive outcomes than older people in standard housing, including improved quality of life following a move to sheltered accommodation. Perceived safety and security, social contact (neighbours and staff), and on-site support were highly regarded. Discussion: Older people had poor knowledge about housing and support options, and felt a move to alternative accommodation would be stressful, but those who had made the move were very satisfied. For all older people, facilitation of pet ownership, bathroom adaptations and safe outdoor spaces (for social contact in a neutral space) were important aspects of a “good” house. Conclusions: Sheltered housing, in which multiple homes are provided within one complex with onsite support, provides significant benefits for social integration and well-being, but does require a move from the person’s home, which was negatively considered by those in standard social housing. Lessons learned: Future social housing designs should be flexible, i.e. adaptable to the needs of the tenants over time to allow “ageing in place”, and should offer a range of house layout options, to allow tenants to choose a home most suitable to their personal lifestyle / support needs. Older people need information to inform housing choices, and support when considering a change of abode. Limitations: This research was performed with older people in a single (although national) social housing scheme. Suggestions for future research: A key objective of future research should be to ascertain whether sheltered housing can facilitate ageing-in-place and whether it mitigates the need to move into residential care, and a cost analysis of this.

Constipation is a common problem and includes symptoms of straining, discomfort and difficulty in passing stool. Mary Rose Day, Teresa Wills and Alice Coffey discuss the advantages and disadvantages of laxatives to combat the condition

Elder abuse (EA) within the population of community dwelling older people living with dementia is significantly more prevalent when compared with the population of older adults without cognitive impairment. Public Health Nurses (PHNs) in Ireland are a key professional service provider group in safeguarding vulnerable populations. Interpretative Phenomenological Analysis (IPA) was utilized to explore the experiences of PHNs in identifying and addressing abuse, among community dwelling older adults living with dementia that was perpetrated by informal caregivers. Semi-structured interviews were conducted with PHNs (n = 5) in Ireland that had in the previous 12 months dealt with a case of elder abuse involving an older adult living with dementia. Analysis of the data revealed three super-ordinate themes; identifying hidden abusive relationships; Complexity – ‘where do I start’; and Isolation. This study provides unique insights from PHNs relevant to safeguarding this particularly vulnerable group. Specific implications for practice and recommendations are presented.

This service evaluation aimed to identify the factors at an interim care unit that contributed to the diversion of patients from long-term care to care at home. A triangulated, mixed methods approach was adopted. Data were collated from an analysis of individual patient case notes; interviews with patients, carers and relatives; and workshops with unit staff. Distinctive and overlapping core themes emerged from the data. Patients and relatives cited having extra time in the unit to adjust, with staff encouragement and persistence to tackle their main problems, in addition to achieving seamless care at home and the ability to envisage a life after hospital. The staff workshops revealed attitudes that supported patient empowerment, shared decision making and patient-centred solutions. The successful diversion of patients from long-term care is multifaceted and dynamic. It is clear that a decision to pursue a different end-point destination has to occur, with patients' and relatives' consent; that is, to avoid transfer from acute care to long-term care. The optimism and self-belief created by this decision drive staff and patients towards the same goal: improved patient outcomes and, for some, eventual diversion from long-term care.

Aging populations and chronic illness increase vulnerability of older people for self-neglect, which is a serious public health issue. Many referrals received by Elder Abuse Services (EAS) in Ireland are categorized as self-neglect. The aim of the research was to observe and describe the living circumstances of a purposive sample of eight older people who were deemed self-neglectful by senior case workers. An exploratory descriptive research design was used. The themes that emerged were early life experiences and lifestyle, disconnectivity, vulnerability, frugality, and service refusal. The majority of participants were content so decisions to live in this way must be respected.

Objective: Our home can have a major impact on our physical and mental health; this is particularly true for older people who may spend more time at home. Older people in social (i.e., public) housing are particularly vulnerable. Housing options for older people in social housing include standard design dwellings or specially designed “sheltered housing.” The most suitable housing model should be identified, with older people consulted in this process. Method: Survey of older people (aged ≥60) living in standard or sheltered social housing. Data were analyzed using descriptive and inferential statistics in SPSS Version 22. Results: Overall, 380 surveys were returned (response rate = 47.2%). All older people had similar housing needs. Those in sheltered housing were more satisfied with the physical home design and reported more positive outcomes. Older people in standard housing were less likely to have necessary adaptations to facilitate aging-in-place. Discussion: Older people in standard housing reported more disability/illnesses, are worried about the future, and felt less safe at home. However, few wanted to move, and very few viewed sheltered housing as an alternative, suggesting limited knowledge about their housing options. Future social housing designs should be flexible, that is, adaptable to the needs of the tenants over time.

Developmental Dysplasia of the Hip (DDH) captures a range of hip disorders which requires early identification and management and as such is a significant public health and primary care issue. The incidence of late diagnosis is higher in Ireland that other countries. Hip ultrasound is not widely practiced in Ireland. After birth, Public Health Nurses (PHNs) practitioners in Ireland may be the first health professional to be alerted to a missed case of DDH. The aim of this paper is to use a case study to illustrate the complexities of public health nursing practice with parents to screen, intervene and manage DDH. The paper highlights the way in which PHNs fulfil their public health role by implementing interventions, at the level of individuals, communities and systems, to address public health issues, informed by the Public Health intervention Wheel (The Wheel). Implications for education and practice are also discussed.

Self-Neglect (SN) can be defined as: This definition is holistic and captures the intentional and choice factors as well as socio-cultural influence of the behaviour and the potential negative impact of SN for the individual, their family and community. A key component of assessment by professionals is the individual’s decision making capacity and ability to understand the consequences of their actions. Occasionally, distorted images and headlines appear in the media such as “A Systems Failure: Pensioner found dead due to Self-Neglect”. There is a general outcry of public rage but the media are not interested in understanding why the vulnerable but competent adult who was self-neglecting is not rescued. A social media heading like this is a nightmare for professionals and services. A range of interrelated factors contribute to health inequalities of older people such as socio-economic and material factors, psychosocial factors and lifestyle factors. Many of these are risk ...

Research spanning 30 years has highlighted discharge planning as a complex area of practice. Discharge co-ordinators are part of the support provided to improve the patient's journey from acute to community settings. The aim of this study was to explore and describe the role of discharge co-ordinators in a healthcare setting. Using an exploratory descriptive research design a convenience sample of discharge co-ordinator nurses (n=6) across a variety of acute care settings in the Republic of Ireland, were interviewed. Thematic analysis revealed that the role of the discharge co-ordinators was multifaceted and a number of factors affected their role. Recommendations for practice include improved discharge planning processes and education.

Self-neglect is a significant international public health issue. Estimates suggest that there may be over one million cases per year in the United States. Aging populations will put more people at risk of self-neglect. This chapter presents background literature, self-neglect definitions and policy context, risk factors, and a brief overview of research on perspectives of self-neglect from both clients and community health and social care professionals. A case study is presented from the perspective of an individual and is used to explore ethical issues therein. A person-centered assessment within a multidisciplinary team approach is required for building a therapeutic relationship with clients. Capacity is a central issue in the management of responses to self-neglect. Ethical considerations of importance for community health and social care professionals include beneficence and nonmaleficence, autonomy and capacity, and respect for people's rights and dignity. A model of ethical justification is presented to explain dilemmas, challenges, and actions. Competence of professionals, multidisciplinary team working, informed consent, privacy, confidentiality, and best interest are also critical considerations. Effective decision making by an interdisciplinary team of professionals needs to be person-centered and give due consideration to the best interest of self-neglecting clients. The purpose of this chapter is to provide an in-depth discussion and examination of ethical issues and challenges relating to self-neglecting clients.

Self-neglect (SN) is a global phenomenon, largely hidden, poorly defined, and a serious public health issue. It can be intentional or unintentional and depends on the individual's capacity. Creating a safe living environment for self-neglecting adults can present complex ethical challenges. The purpose of this research was to develop and evaluate the psychometric properties of an instrument to measure professional's perceptions of self-neglect. A descriptive cross-sectional design was used in this two-stage study. Stage 1 involved the generation of an item pool (90 items), face and content validity; and pilot testing of the instrument. In stage 2, the questionnaire was posted to a national sample of community health and social care professionals (n=566) across Ireland, with a 60% response (n=339). Exploratory factor analysis (EFA) was conducted using scale development guidelines to identify scales and subscales of the instrument. Construct validity was established using EFA. The result was a 37-item SN instrument, composed of five factors: environment, social networks, emotional and behavioural liability, health avoidance, and self-determinism which explained 55.6% of the total variance. Factor loadings were ≥0.40 for all items on each of the five subscales. Cronbach's alpha (α) for four subscales ranged from 0.83 to 0.89 and one subscale was 0.69. The SN-37 can be used not only to measure SN, but also to develop interventions in practice. Further testing of the SN-37 in primary care settings with diverse populations is recommended.

Self-neglect is a worldwide and serious public health issue that can have serious adverse outcomes and is more common in older people. Cases can vary in presentation, but typically present as poor self-care, poor care of the environment and service refusal. Community nurses frequently encounter self-neglect cases and health and social care professionals play a key role in the identification, management and prevention of self-neglect. Self-neglect cases can give rise to ethical, personal and professional challenges. The aim of this article is to create a greater understanding of the concept of self-neglect among community nurses.

Self-neglect (SN) is a serious public health issue that is largely hidden. Ageing demography will

As the population ages, the risk and prevalence of urinary incontinence (UI) will increase. Although this is the case, many women do not seek help or treatment. It is therefore important to investigate women's knowledge of UI. This pilot study aimed to describe community-dwelling women's knowledge of UI. A convenience sample method was used to recruit 50 community-dwelling women aged 50 and over. Some 36 participants completed a demographic questionnaire and the Urinary Incontinence Knowledge Scale (UIKS)—a response rate of 72%. The findings indicated that participants had poor knowledge of UI, principally in relation to risk, prevention, treatment and management factors. Fewer than 20% of participants indicated they had been given information on bladder and bowel health issues. The findings suggested that women had unmet educational needs relating to UI. Community nurses have a key role to play in promoting targeted awareness and continence education advice regarding UI to community-dwelling women.

Health of populations is determined by a multitude of contextual factors. Primary Health Care Reform endeavors to meet the broad health needs of populations and remains on international health agendas. Public health nurses are key professionals in the delivery of primary health care, and it is important for them to learn from global experiences. International collaboration is often facilitated by academic exchanges. As a result of one such exchange, an international PHN collaboration took place. The aim of this paper is to analyse the similarities and differences in public health nursing in Ireland and Norway within the context of primary care.

Constipation is a common problem affecting many older people's quality of life. The aim of the study was to describe and compare the frequency of use of laxative medication in Irish adults, aged 65 years and older, from the community and a long-term care setting. Participants (n=207) were part of the Irish ELDERMET project. The project aims to find out how diet and lifestyle influence, and are influenced by, the bacteria in the gut, and how this knowledge can be used to promote health in older Irish people. It has recruited over 450 people, aged 65 and older, and will use the information gathered from the extensive proforma to develop-recommendations, as well as functional foods/functional food ingredients specifically designed to promote and support health in older populations. Data were collected between June 2008 and April 2010 using a survey questionnaire. A quantitative descriptive correlational design was used. Analysis was conducted using PASW Statistics 18.0. Participants in long-term care received a greater number of both laxatives and prescribed medications than community-dwelling participants. Increased polypharmacy was also seen in participants taking laxatives, with participants in long-term care significantly (p

This paper reports on the development, delivery, content and student evaluation of a comprehensive elder abuse and self-neglect workshop for public health nursing and social work students.The workshop provided an interdisciplinary shared learning experience for the students to prepare them for their critical role in safeguarding vulnerable adults. The aim of the workshop was to increase knowledge, awareness and understanding of roles and responsibilities and critical practice problems in the prevention and management of elder abuse and self-neglect. The shared learning approach provided clarity on roles and responsibility, valuing and respecting the contribution of each team member. The importance of building communication and trust with team members and clients was seen as critical. Through case studies and group discussion, assessment and practice skills were developed and awareness heightened on the complexity of the critical practice problems and ethical issues.

This is a two-part unit on self-neglect. Part 1 examined definitions of the phenomenon, its characteristics and risk factors. This article, part 2, discusses nurses' role in the identification and assessment of self-neglect. Due to its complex nature, a multi-agency and multidisciplinary approach is required to meet and protect the needs of vulnerable adults.

Objectives Mental health services for older people in primary care are relatively underdeveloped. This study has sought to determine the nature and extent of mental health problems in older people presenting to primary care and to compare this with the detection and management of mental health problems by the primary health care team (PHCT). Method Participants were patients aged 65 years and above attending a representative inner city general practice. Screening tools included the General Health Questionnaire (GHQ-28), Hospital Anxiety and Depression Scale (HADS), Mini Mental State Examination (MMSE). The PHCT used a brief checklist to rate participants for the presence of mental health problems. Follow-up interviews using the Geriatric Mental State (GMSA), Cambridge Examination for Mental Disorders in the Elderly (CAMDEX)—cognitive subscale (CAMCOG), National Adult Reading Test (NART), were carried out. Results A high level of psychological morbidity was identified at screening (48.1%). There was a considerable degree of agreement between the HADS and GMSA, and the MMSE and GMSA at follow-up. Agreement rates between the PHCT and initial screening tools were low suggesting under-recognition of mental health problems at primary care level by the PHCT. Contributory factors included: short consultation times with a concentration on physical symptoms; few patients presenting explicitly with mental health problems; few decisions to treat or refer patients; and the general practitioners tended to monitor, or defer decisions. Conclusions This study found lower levels of severe mental health problems, especially depression, than reported elsewhere, but higher prevalence of psychological distress. High levels of physical and mental health co-morbidity were found. These findings suggest that planning for primary care services needs to adopt a flexible assessment model. The development of effective, time-limited protocols and screening tools to assist the PHCT in improving their identification rates is recommended. This needs to be supported by the availability of appropriate treatments for the psychological distress. Copyright © 2002 John Wiley & Sons, Ltd.